This form is to be used to transfer a domain name from one Registrant (holder/owner) to another in the event that the online Registrant Transfer process can't be used.
Please note that there is a fee of $39.95 + GST for manual processing of this form, whereas the online Registrant Transfer process is free of charge.
I. Domain Name Information
Please provide the domain name(s) that you wish to change the Registrant for below:
Domain Name(s): ________________________________________________________________
II. Current Domain Registrant Information
| Domain Registrant Name: | _________________________________ |
| If an organisation, name of representative: | _________________________________ |
| Contact email address: | _________________________________ |
| Type of Identification provided (circle one): | _________________________________ |
| Type of Identification provided (circle one): | Drivers Licence / Passport / Company Letterhead
Other _________________________________(please specify) |
III. Current Domain Registrant Authorisation
I, _________________________________, request that the Domain Name registration(s) listed in Section I be transferred to the individual and/or organisation listed in Section IV of this document.
Please sign and date this letter to indicate your authorisation of this transfer.
| Signature: | ________________________ | Date: | ________________________ |
| Print Name: | ________________________ |
IV. New Registrant Information
Please provide contact information for the new registrant below. These contact details will be the official registrant for the Domain Name(s) being transferred.
| New Registrant Name: | _________________________________ |
| If an organisation, name of representative: | _________________________________ |
| Street Address: | _________________________________ _________________________________ |
| Town/City: | _________________________________ |
| Postcode: | _________________________________ |
| Telephone Number: | _________________________________ |
| Fax Number (if applicable): | _________________________________ |
| Mobile Phone Number (if applicable): | _________________________________ |
| Email Address: | _________________________________ |
V. New Registrant Account
If you have an existing account at Freeparking please provide your current username and password details below. Alternatively, if you do not have an account with Freeparking, please specify a username and password that you would like to use (if the username chosen is already taken, Freeparking will assign a similar username for you).
| Username: | _________________________________ |
| Password: | _________________________________ |
VI. Billing Information
Please provide the credit card information that is to be used by Freeparking to make payment for the $39.95 + GST processing fee associated with this form.
| Cardholder's Name: | _________________________________ |
| Credit Card Number: | _________________________________ |
| Card Expiry Date: | _________________________________ |
| Cardholders Signature: | _________________________________ |
VII. Terms and Conditions
Both the current and new registrant must read and agree to the Freeparking Terms and Conditions, and the Freeparking Transfer Terms below;
| a) | I, the current registrant, confirm that I am authorised to action a change of registrant for this domain. | [ ] |
| b) | I, the current registrant, agree to release Freeparking from any further obligation to itself after the completion of the change of registrant processes. | [ ] |
| c) | I, the prospective registrant, confirm that I have requested the change of registrant, and that I have read and accepted all relevant terms of service set out in the registrant's agreements. | [ ] |
| d) | I, the prospective registrant, agree to indemnify Freeparking, their agents, officers, and employees for any costs, losses, or liabilities incurred in the reasonable performance of their duties in processing this request, or in dealing with claims arising from the allocation or use of the name. | [ ] |
| e) | I, the prospective registrant, declare that there is no reason why the change of registrant request should not be actioned. | [ ] |
| f) | I, the prospective registrant, agree to allow Freeparking to seek further proof of identity, or evidence of my ability, to meet the conditions for holding a domain name. | [ ] |
Please review the Freeparking Terms and Conditions at www.freeparking.co.nz/policy and indicate below that you have read, understand and agree to these Terms and Conditions:
Current Registrant:
I have read, understand and agree to the Freeparking Terms and Conditions and Transfer Terms
| Signature: _________________________________ | Date: _________________________________ |
New Registrant:
I have read, understand and agree to the Freeparking Terms and Conditions and Transfer Terms
| Signature: _________________________________ | Date: _________________________________ |
| Please complete this form and fax or post it to: | |
| Fax (06) 757 2883 - Within NZ +64 6 757 2883 - International | Post Freeparking Level 2, 2 Devon Street East New Plymouth, New Zealand |